Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 9430 | NV |
NPI | 1043305972 |
---|---|
Provider Name | Vijay B. Goli |
First Address | Las Vegas, NV 89113-1981 |
Second Address | Las Vegas, NV 89128-0373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 01/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043305972 | (05) | NV |
G58962 | (02) |